Page 45 - herina surgery and possible lawsuits

Figure 17: Shrinkage properties

of different meshes.
Prolene shrinks 75-94%,
PTFE shrinks 40-50%,

Vypro II shrinks 29%,
Ultrapro shrinks < 5%.
Sofradim shrinks < 5%.

(3) The technique of implantation

i. Anterior approach and prosthetic placement
ii. Anterior approach with combined anterior-posterior prosthetic placement
iii. Anterior approach with posterior prosthetic placement

iv. Posterior approach : Open or Laparoscopic
In each approach, layer of abdominal wall, folding of mesh and fixation of prosthesis play
big role in tissue response and recurrence.[79]

(4) The clinical scenario
i. Symptoms: duration, pain, severity
ii. Associated diseases: immunological, infection, obesity
iii. Emergency surgery

iv. Anatomy: defect size and location, extent, recurrence
v. Future risk: need for prostatectomy
The surgeon must weigh the relative risks and benefits of each prosthetic for each given

clinical scenario.
The surgeon should know the ideal requirement of prosthesis.

The characteristic of idea! prosthesis should be[79]
1. Bio- chemically inert
2. Invoke a favorable host response.

3. Stimulate fibroblastic activity to allow incorporation into tissue than encapsulation
4. Possess good handling characteristics while operating.
5. Pliable so that no stiffness been felt by patients.
6. Strong enough to withstand pressure to prevent recurrence.

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